While there is extensive research documenting the effects of hospital acquisitions on cost and quality, impacts on access to care have received less attention. Acquirers may limit access by closing an acquired hospital or eliminating individual service lines. However, acquirers may have more resources to improve care delivery. We study the impact of hospital acquisitions on obstetric care in rural markets, where there may be heightened concern about the availability of local care options. We find that acquired rural hospitals are substantially more likely to close obstetric units, with resulting large reductions in the number of births at the hospital. We find suggestive evidence of spillovers to general maternal health care resources and delayed prenatal care in the affected communities, but little evidence of effects on health outcomes. We find decreases in maternal transfers and increases in procedures consistent with women shifting to delivering in better resourced hospitals.

We examine how health insurance expansions influence the entry and location decisions of health care providers. While it is generally expected that reductions in consumer prices following insurance expansions will prompt supply-side growth to meet increased demand (Arrow, 1963), we demonstrate both theoretically and empirically that expansions of insurance with low, regulated provider reimbursements (e.g., Medicaid) can instead lead the supply side to contract. Additionally, we show that expansions of insurance with high, market-based prices (e.g., private coverage) can reduce acceptance of public coverage even as they drive growth in the overall concentration of providers.

Regulators often enact price restrictions with the goal of improving access to products at affordable prices. However, the design of these regulations may interact with firm entry and exit decisions in ways that mitigate the effects of pricing regulation or eliminate access to certain products entirely. In the US individual health insurance market, the Affordable Care Act established community rating areas made up of groups of counties in which insurers must offer plans at uniform prices, but insurers do not have to enter all counties in a rating area. They may partially enter a rating area by entering some counties but not others. Allowing partial entry creates trade-offs in rating area design. Larger areas may support more competition, but heterogeneous areas may promote partial entry as firms choose to not enter high cost areas. To evaluate these trade-offs, I develop a model of insurer entry and pricing decisions and investigate how insurers respond to rating area design. I find that banning partial entry increases entry overall, but at the cost of higher average prices since costs are higher in previously non-entered counties. On net, consumer welfare increases. Further, increasing the size of a rating area improves consumer welfare most when marginal costs are similar. Regulators must balance promoting competition with pooling high and low cost consumers in rating area design.